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Current Understanding and Management Options

Lambert A. Wu, MD; Joseph F. Malouf, MD; Joseph A. Dearani, MD; Donald J. Hagler, MD; Guy S. Reeder, MD; George W. Petty, MD; Bijoy K. Khandheria, MD

Arch Intern Med. 2004;164:950-956.

There is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalva-inducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.

From the Division of Cardiovascular Diseases and Internal Medicine (Drs Wu, Malouf, Reeder, and Khandheria), Department of Cardiovascular Surgery (Dr Dearani), Division of Pediatrics (Dr Hagler), and Department of Neurology (Dr Petty), Mayo Clinic, Rochester, Minn. The authors have no relevant financial interest in this article.

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